Gabapentin and Pregabalin for the Treatment of Neuropathic Pain: A Review of Laboratory and Clinical Evidence

Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and type 2 diabetes. It affects over 90% of the diabetic patients. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. DPN is often misdiagnosed and inadequately treated. Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvant in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. The purpose of this review is to examine proposed mechanisms of DPN, summarize current treatment regimen. A better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies. Delta Med Col J. Jan 2019 7(1): 35-48

Download Full-text

Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence

Physical Therapy in Sport ◽

10.1016/j.ptsp.2005.10.002 ◽

2006 ◽

Vol 7 (1) ◽

pp. 36-49 ◽

Cited By ~ 112

Author(s):

Robert J. Nee ◽

David Butler

Keyword(s):

Neuropathic Pain ◽

Clinical Evidence ◽

Peripheral Neuropathic Pain

Download Full-text

Pharmacologic basis for the use of selective norepinephrine reuptake inhibitors for the treatment of neuropathic pain conditions

Mental Health Clinician ◽

10.9740/mhc.2015.11.284 ◽

2015 ◽

Vol 5 (6) ◽

pp. 284-288 ◽

Cited By ~ 1

Author(s):

Michael Webster

Keyword(s):

Neuropathic Pain ◽

Pain Management ◽

Tricyclic Antidepressants ◽

Clinical Evidence ◽

Additional Research ◽

Human Trials ◽

Primary Literature ◽

Growing Body ◽

Current Guidelines ◽

Norepinephrine Reuptake

Abstract Introduction This article will review the pharmacologic and clinical evidence supporting the use of selective norepinephrine reuptake inhibitors, most notably atomoxetine, for the treatment of neuropathic pain states. Many medications initially marketed for psychiatric indications have gained widespread use for their analgesic properties after additional research. Methods In search of alternative treatments for neuropathic pain, current guidelines, published reviews, and primary literature, including both rodent and human trials, were reviewed. Results and Discussion The first group of medications to gain widespread use in pain management was the tricyclic antidepressants. As further research was completed and serotonin norepinephrine reuptake inhibitors began to be utilized for their analgesic properties, a growing body of evidence began to indicate that the analgesic properties of these medications were primarily due to the blockade of norepinephrine reuptake with serotonin playing only a minimal role.

Download Full-text

Promising treatments for neuropathic pain

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140157 ◽

2014 ◽

Vol 72 (11) ◽

pp. 881-888 ◽

Cited By ~ 15

Author(s):

Pedro Schestatsky ◽

Liliane Vidor ◽

Pablo Brea Winckler ◽

Tatiane Gomes de Araújo ◽

Wolnei Caumo

Keyword(s):

Neuropathic Pain ◽

Clinical Practice ◽

Clinical Evidence ◽

State Of The Art ◽

The State ◽

Daily Clinical Practice ◽

Present Review ◽

Treatment Modalities

In the last few years the understanding of mechanisms and, consequently, the diagnosis of neuropathic pain (NP) has becoming progressively clearer in clinical practice. However, the treatment of such condition remains challenging so far. One of the reasons for such difficulty is the diversity of mechanisms involved in NP generation and its persistency. In the present review we discuss several treatment modalities for NP that are scantily applied in daily clinical practice. For that, we collected positive clinical evidence of unusual and SECS (Safe, Easy, Cheap, and Sensible) approaches for NP. The aim of this review is not to establish the “state of the art” or rigid guidelines for NP treatment. In a different way, we only want bring new possibilities of treatment to the readers and also to motivate investigators to confirm those positive preliminary but promising results for NP reliev.

Download Full-text

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use

Pain and Therapy ◽

10.1007/s40122-016-0060-3 ◽

2016 ◽

Vol 5 (2) ◽

pp. 149-169 ◽

Cited By ~ 20

Author(s):

Ralf Baron ◽

Massimo Allegri ◽

Gerardo Correa-Illanes ◽

Guy Hans ◽

Michael Serpell ◽

...

Keyword(s):

Neuropathic Pain ◽

Clinical Evidence ◽

Treatment Guidelines ◽

Localized Neuropathic Pain

Download Full-text

Management of Chronic and Neuropathic Pain with 10 kHz Spinal Cord Stimulation Technology: Summary of Findings from Preclinical and Clinical Studies

Biomedicines ◽

10.3390/biomedicines9060644 ◽

2021 ◽

Vol 9 (6) ◽

pp. 644

Author(s):

Vinicius Tieppo Francio ◽

Keith F. Polston ◽

Micheal T. Murphy ◽

Jonathan M. Hagedorn ◽

Dawood Sayed

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Spinal Cord Stimulation ◽

High Frequency ◽

Pulse Width ◽

Clinical Evidence ◽

Dynamic Range ◽

Large Diameter ◽

Dorsal Column ◽

The Body

Since the inception of spinal cord stimulation (SCS) in 1967, the technology has evolved dramatically with important advancements in waveforms and frequencies. One such advancement is Nevro’s Senza® SCS System for HF10, which received Food and Drug and Administration (FDA) approval in 2015. Low-frequency SCS works by activating large-diameter Aβ fibers in the lateral discriminatory pathway (pain location, intensity, quality) at the dorsal column (DC), creating paresthesia-based stimulation at lower-frequencies (30–120 Hz), high-amplitude (3.5–8.5 mA), and longer-duration/pulse-width (100–500 μs). In contrast, high-frequency 10 kHz SCS works with a proposed different mechanism of action that is paresthesia-free with programming at a frequency of 10,000 Hz, low amplitude (1–5 mA), and short-duration/pulse-width (30 μS). This stimulation pattern selectively activates inhibitory interneurons in the dorsal horn (DH) at low stimulation intensities, which do not activate the dorsal column fibers. This ostensibly leads to suppression of hyperexcitable wide dynamic range neurons (WDR), which are sensitized and hyperactive in chronic pain states. It has also been reported to act on the medial pathway (drives attention and pain perception), in addition to the lateral pathways. Other theories include a reversible depolarization blockade, desynchronization of neural signals, membrane integration, glial–neuronal interaction, and induced temporal summation. The body of clinical evidence regarding 10 kHz SCS treatment for chronic back pain and neuropathic pain continues to grow. There is high-quality evidence supporting its use in patients with persistent back and radicular pain, particularly after spinal surgery. High-frequency 10 kHz SCS studies have demonstrated robust statistically and clinically significant superiority in pain control, compared to paresthesia-based SCS, supported by level I clinical evidence. Yet, as the field continues to grow with the technological advancements of multiple waveforms and programming stimulation algorithms, we encourage further research to focus on the ability to modulate pain with precision and efficacy, as the field of neuromodulation continues to adapt to the modern healthcare era.

Download Full-text